Medications for Erectile Dysfunction (Impotence)

The information provided here is meant to give you a general idea of what to expect from each of these medications. Only the most common side effects are included, so ask your healthcare provider if there are any precautions specific to your case. Use each of these medications as recommended by your doctor or according to the instructions provided with the medication. If you have further questions about usage or side effects, contact your doctor.

There are 3 types of medical treatments available for erectile dysfunction (ED): pills, urethral inserts, and injections.

Prescription Medications

Sildenafil

Vardenafil

Tadalafil

Avanafil

Alprostadil

Transurethral alprostadil

Intracavernosal alprostadil

Sildenafil

Sildenafil was developed to treat heart disease, but during its clinical trials the subjects noticed they were having erections. Sildenafil works best between 1 and 2 hours after taking it. Sexual function improves by a factor of 3 to 4; 4 out of 5 patients taking the drug report improvement.
Sildenafil has been shown to be effective in ED associated with diabetes, spinal cord injury, and medications used to treat depression.

In contrast to the other agents listed below, sildenafil does not produce an erection in the absence of sexual stimulation. It merely enhances the response. Take sildenafil about an hour before planned sexual activity.

These newer drugs have the same efficacy, safety profile, and cost effectiveness as sildenafil. However, the following are major differences you should be aware of:

Food, especially fatty food, can delay the absorption of sildenafil, vardenafil, and avanafil, but not tadalafil.

The duration of action of these drugs are different:

4 to 5 hours for sildenafil, vardenafil, and avanafil

Up to 36 hours for tadalafil

Alprostadil

There are 2 types of alprostadil:

Transurethral alprostadil

Intracavernosal alprostadil

Alprostadil acts directly on the blood vessels in the penis to cause an erection. It can be inserted into the urethra (urinary tube in the penis) with a special device or injected with a small needle. Erection occurs in 8-10 minutes and lasts 30-60 minutes. The injection is effective in about 65%-85% of users; the insert is effective in about 65%.
The maximal number of injections per week is 3.

Possible side effects include:

Lightheadedness

Low blood pressure

Pain in the penis

Problems from the injecting needle

Prolonged, painful erection (priapism) (0.4% of users)

Bleeding in patients on blood thinners

Special Considerations

Follow these general medication guidelines:

Take your medication as directed. Do not change the amount or the schedule.

Do not stop taking prescription medication without talking to your doctor.

Do not share prescription medication.

Ask what results and side effects to expect. Report them to your doctor.

Some medications can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one medication. This includes over-the-counter medication and herb or dietary supplements.

Plan ahead for refills so you don’t run out.

When to Contact Your Doctor

Contact your doctor if any of the following occur:

A side effect that troubles you

Priapism (prolonged, painful erection)—This condition can be dangerous. If 4 hours have passed and your penis still has not relaxed, seek emergency medical care.

Warning About Medications Not Prescribed by Your Doctor

Use caution and talk to your doctor before taking any over-the-counter medications for impotence. Some of them may be unsafe.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.